HOSPEEM-EPSU 4. FACHKONFERENZ project Ergonomic hospital design is NOT a luxury increasing the financial burden of hospitals! Building design to prevent MSDs can reduce significantly operational hospital costs COST-EFFECTIVENESS OF ERGONOMIC HOSPITAL DESIGN PARIS 25.03.2015 Prof.Dr. Ing. habil. T.Guthknecht Lausanne Health & Hospitality Group
Analysis Cost-Effectiveness of Ergonomic Hospital Design A 1 Context analysis 10 operational Functional costs of hospitals Analysis 1.2 Approach by introducing ergonomic KEY concepts POINTS: [01] Situation [02] Challenges [03] Grey Performance Analysis [04] Key Ergonomic Design Issues [05] Focus: Alternatively Usable Time for Care [06] Joining Economy and Design Concepts for More Quality [07] A New Concept: Integral Process Design [08] Business Design embraces Building Design [09] Using New Tools: PROBAU Planning-Software [10] Summary and Conclusions
[01] Situation Ergonomic work flow requirements are neglected in today s hospital design. The separation of of operational concepts and building design lead to inefficient buildings. Health facility design can contribute to cost reductions by providing more efficient and more ergonomic work conditions.
[02] Challenges The evaluation of transfer procedures in acute care facilities contributes to better design. The assessment of the dynamic mobility status of acute patients shows the true workload in a dynamic changing care situation.
[02] Challenges Dynamic mobility status: dynamic data lead to mobility average
[02] Challenges Dynamic mobility status: acute care mobility assessment: example ~23% of patients in need of support >17.7% >3.6% >2.1%
Building conditions in many health lead to unsafe and dangerous work procedures. Transfer at the bedside: Transfer time mobility D patient, 3staff, 13min [02] Challenges Unergonomic work flows require excessive use of staff.
[02] Challenges Most sanitary cells in hospitals are to small Text. to allow access for transfer support equipment. Transfer to the sanitary cell: Transfer time mobility B patient, 2staff, 11min Human support is inadequate due to tight space conditions.
[02] Challenges The lack of transfer equipment leads to dangerous and unergonomic work sequences in the operating theatres. Crammed situations in the OT are hygienically and ergonmically critical. Transfer at the operating table without support, ergonomically critical, and hygienically dangerous
[03] Grey Performance Analysis Patient rooms are often so small that the movement of the rear bed rquires the shifting of room furniture. As a result: unnecessary and time consuming lifting. Unnecessary additional work too small area forces to furniture shifting
[03] Grey Performance Analysis Patient rooms barriers in sanitary cells lead to expensive efficiency loss Patient sanitary cells have often barriers which reduce access e.g. to the shower and toilet. In consequence: additional workload and quality loss for the patient.
[03] Grey Performance Analysis Some patient furniture does not enable patients with mobilty limitations (e.g. due to medical intervention) to stand up and get out of the chair on their own. The result is extra work load for the nursing staff with unnecessary lifting. Patient rooms inadequate patient furniture
[03] Grey Performance Analysis Unnecessary restacking of linnen is time consuming. Combined transport and storage units can avoid unnecessary restacking. Linnen unnecessary additional workload
[03] Grey Performance Analysis Unnecessary restacking of goods: Combined transport and storage units can avoid unnecessary restacking. Consumer goods unnecessary additional workload
[04] Key Ergonomic Design Issues problems in sanitary cells today: No direct (straight) access to the toilet. No access for patient transfer equipment As a result: unnecessary extra work Lausanne Health & Hospitality group
[04] Key Ergonomic Design Issues new standards for sanitary cells: MINIMAL SIZE of sanitary cells: 2.2 x 2.2m. Direct (straight) access to the toilet. Care-support possible with transfer equipment. Lausanne Health & Hospitality group
Longer building but shorter work path Nurses walking distance due to visual blockade
[05] Focus: Alternatively Usable Time for Care The goal for higher efficiency must be combined with an economic solidarity model. Efficiency Workflow optimization together with quality care standards Better work flow efficiency must be accompanied by definite quality standards of care.
Logistics Logistics Sufficient support equipment to cope with peak load. Quantity of support equipment to be designed in a way to enable an overlapping workflow.
[06] Joining Economy and Design Concepts for More Quality making cost parameters comparable A hospital is planned (e.g.) for: Additional costs for ergonomic work conditions and improved income: 100 mio 10 mio Due to tight investment budget the decision is taken that it is out of the question to increase the investment by 10%. Does this represent an economically sustainable decision?
[06] Joining Economy and Design Concepts for More Quality making cost parameters comparable The projekt (100 mio ) is financed to 3% Annual project financing costs : 3 000 000 000 / J Additional financial costs (re. 10mio ) 300 000 000 / J Potentially alternative usable time of care p.a. due to additional ergonomic measures:(12 FTE zu 60 000 ) 720 000 000 / J In consequence: the investment is not sustainable without the additional budget!
Integral Process Design Planning should integrate processes and interfaces. Planning supports Cooperation between processes. Cooperation factor ist is part of profit & loss account.
[01] Using New Tools: PRO-BAU software: Building Assessment - Unit PRO-BAU shows the interconnection between investment and daily operation. Immediate results with Default Based Evaluation. From Trend-View to Detailled-Result: Planning with PROBAU enables results from broad scope to detailled focus.
[01] Using New Tools: PRO-BAU example: Building Assessment - Unit e.g.: A Hospital requires new care wards Interim investments are necessary. Challenge: How can the existing care units be more efficient and prepare the change? [1] Realisation of a fast trend analysis. [2] Realisation of a detail project.
[10] Summary and Conclusions Ergonomics in hospital design is an indispensable feature of future hospital design. Ergonomic design improves work conditions and enables operational cost reductions. Joining efficiency and quality care standards enable quality-oriented health facilities. Prospective planning is necessary: Building design is embraced by business design.
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